Gout tophus on an intradural fascicle: a case description

Abstract

Study design: Case report and review of literature.

Objective: Detailed description of case and review of literature to determine its uniqueness with special regard to intradural gout tophus formation without any boney attachment or underlying systemic gout. Gout tophi commonly involve the peripheral joints of the upper and lower extremities. Rarely, gout tophi are located within the spinal cord, especially without any underlying hyperuricemia.

Methods: We report the case of a 64-year-old patient presenting with radiculopathy along the right L2-dermatome and bladder dysfunction and review literature for further discussion.

Results: Imaging studies showed a partly calcified round intradural lesion at the level L2 without contrast enhancement. The lesion was removed via a hemilaminectomy L2. It was adherent to a dorsal sensory fascicle exiting with the L2 nerve root. The neuropathological examination showed a gout tophus. Serologic testing revealed no signs of hyperuricemia.

Conclusion: To the best of our knowledge, this is the first report of a gout tophus originating from an intradural fascicle and without any boney attachment or underlying systemic gout. The literature is reviewed and possible pathophysiological mechanisms are discussed.

Keywords: CSF; Gout tophus; Intradural; Nerve fascicle; Uric acid.